S1024 Real-World Experience With Non-Endoscopic Screening for Barrett’s Esophagus (BE): Strong Guideline Adherence With Highest Positivity in Patients Meeting American College of Gastroenterology (ACG) BE Screening Criteria

Introduction: Non-endoscopic biomarker screening for Barrett’s esophagus (BE) is commercially available in the U.S. However, its real-world use outside of research settings is not described. The American College of Gastroenterology (ACG) recommends these tests as an alternative to endoscopy in patients with gastroesophageal reflux (GERD) and at least 3 of 6 additional risk factors. The American Gastroenterological Association (AGA) also recommends screening in patients with 3 risk factors, but includes chronic GERD as just one of 7 risk factors. This study aimed to evaluate the real-world use of these tests, focusing on adherence to societal guidelines for patient selection, the impact of societal screening criteria on the number of patients screened, and the impact of these criteria on the likelihood of a positive test. Methods: This retrospective study analyzed data from a commercial database of EsoCheck®, a swallowable balloon capsule device, followed by EsoGuard® (EG), a methylated biomarker test (mVIM and mCCNA1), performed in an office or health fair setting. Data from the laboratory’s clinical database were analyzed in an institutional review board-approved study. Results: Between January 2023 and June 2024, 11,355 patients underwent testing, with a binary result reported in 10,566 (93.4%). Overall, 83.6% of patients met at least one society’s criteria. Almost twice as many patients met AGA criteria as ACG criteria. Nearly half of the AGA cohort did not have symptomatic GERD. The overall positivity rate was 16.6%. The AGA cohort had a lower positivity rate than the ACG cohort (P < 0.01). The non-GERD AGA cohort had a lower positivity rate than either the ACG cohort or full AGA cohort (P < 0.0001). The cohort not meeting societal criteria had the lowest positivity rate. Conclusion: The vast majority of patients in this real-world cohort undergoing non-endoscopic biomarker screening for BE met at least 1 professional society’s criteria, indicating strong guideline adherence. Use of the less stringent AGA criteria doubled the number of patients screened while use of the more stringent ACG criteria resulted in a higher yield of the test, especially compared to a non-GERD AGA cohort. Over three-fourths of patients had a negative EG test and required no further testing.